Provider Demographics
NPI:1639139280
Name:PERELMAN, STANLEY GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:GEORGE
Last Name:PERELMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 WINTHROP ST
Mailing Address - Street 2:#202
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3718
Mailing Address - Country:US
Mailing Address - Phone:412-682-8172
Mailing Address - Fax:412-682-8196
Practice Address - Street 1:4609 WINTHROP ST
Practice Address - Street 2:#202
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3718
Practice Address - Country:US
Practice Address - Phone:412-682-8172
Practice Address - Fax:412-682-8196
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0814X
PAPA 003465-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095531Medicare ID - Type Unspecified